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Mediclaim Plans starting @ Rs 250* / month

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New India Assurance - Mediclaim 2012 Policy

New India Assurance Co Ltd. is a Government multinational general insurance company having its headquarters in Mumbai and a global presence in more than 27 countries. Sir Dorabji Tata founded the company in 1919 and since then it has been ruling the market in the non-life insurance business.

New India Assurance's Mediclaim 2012 Policy is intended to shield people against the whopping hospitalization costs. This plan is an excellent Mediclaim Policy with notable features like no maximum entry age limit, high cumulative bonus. Compared to Mediclaim 2007, this revised version is packed with valuable benefits and worth considering.

Highlights of Senior Citizens Mediclaim Policy

  • Available for persons between the age of 18 and 65 years
  • Liability cover for Cataract claims up to 10% of Sum Insured or Rs.50,000 whichever less, for each eye
  • Pre-acceptance medical check required only for those above the age of 50
  • Cover for Ayurvedic/Homoeopathic/Unani treatment
  • Coverage for Congenital (External) Diseases from the 5th year up to 10% of the Sum Insured
  • Income Tax Benefit for the premium paid under Section 80D of Income Tax Act.

Scope of cover

Indivdual Plan

Entry Age

For children : 91 days

Adults :

Minimum : 18

Maximum : 60

Number of Members Covered

Maximum Members : 4

Maximum Adults : 2

Maximum Children : 2

Sum Insured

1 lakh - 8 Lakh


discount

Family Discount

Policy Periods Available

1 year


Pre-Policy Medical Check-up

Above 50 years

Family Floater Plan

Entry Age

For children : 91 days

Adults :

Minimum : 18

Maximum : 60

Number of Members Covered

Maximum Members : 6

Maximum Adults : 4

Maximum Children : 2

Sum Insured

1 lakh - 8 Lakh


discount

Family Discount

Policy Periods Available

1 year


Pre-Policy Medical Check-up

Above 50 years

Important Features

Day Care Treatments
Definition
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Day Care Treatments

Includes surgical processes conducted using local or general anaesthesia which requires less than 24 hours of hospitalization because of technological advancement in healthcare. Each company has a specific list of processes which are covered under this category.

Due to scientific progress, some procedures/treatments do not require you to be hospitalized for a minimum of 24 hours to raise a claim. This plan covers 32 such procedures.

No-Claim Benefits
Definition
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No-Claim Benefits

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For every claim free year, based on the age and the sum insured, the discount offered on the premium varies between 2% up to a maximum of 15%.

Organ Donor Cover
Definition
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Organ Donor Cover

Includes coverage for in-patient hospitalization expenses, offered to an organ donor for his/her treatment on harvesting an organ for the insured.

If you ever have to opt for organ donation, the hospitalization expenses (excluding the cost of the organ) on the procedure for the donor will be covered up to the sum insured.

Pre Hospitalization
Definition
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Pre Hospitalization

Medical expenses incurred immediately before the insured individual is hospitalized are covered under this benefit. Usually, expenses up to 30 to 90 days before hospitalization are covered under the policy only after the in-patient hospitalization claim is accepted by the insurance company.

The insurance company will compensate you for the medical expenses related to your hospitalization 30 days before the hospitalization.

Post Hospitalization
Definition
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Post Hospitalization

Medical expenses incurred immediately after the hospitalization are covered under this benefit.The coverage under this benefit would be available only for approved in-patient hospitalization claim is accepted by the insurance company. Usually, expenses up to 30 to 180 days post discharge are covered under the policy.

The insurance company will pay you for the medical expenses related to your hospitalization 60 days post hospitalization.

Good to Have Benefits

Daily Hospitalization Allowance
Definition
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Daily Hospitalization Allowance

Includes lump sum compensation offered in some plans on a daily basis after every 24 hours of hospitalization.The amount offered under this benefit could be used to cover expenses additional to hospitalization expenses.

Benefit of Hospital Cash at the rate of 0.1% of Sum Insured per day of Hospitalization for every admissible claim and for each member.

Health Check-up
Definition
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Health Check-up

Includes complimentary health check-up provided by the insurance companies for certain health insurance plans.

At every third renewal, a compensation towards the health checkup is provided up to Rs.5,000 or 1% of the average Sum Insured; whichever is lower.

Non- Allopathic Treatment Expense Cover
Definition
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Non- Allopathic Treatment Expense Cover

Includes coverage for expenses on treatment which do not use allopathic methods like Aurveda, Homeopathy, etc. The terms and conditions are different for different policies. This benefit is also refered to as Ayush benefit or Alternative treatment by some the insurers.

You can claim for any treatment sought through alternate medicine like Ayurveda, Unani or Homeopathy up to a maximum of 25% of the sum insured. This claim will be honored as per the policy terms only if you seek the stated treatment in a Government Hospital or any institute duly recognized by the Government or any other governing body.

Emergency Ambulance
Definition
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Emergency Ambulance

Includes coverage for expenses on ambulance for hospitalization of the insured.

This plan provides ambulance cover for up to 1% of the sum insured.

Value Adds

FREE LOOK PERIOD
Definition
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FREE LOOK PERIOD

For any reason, should you decide not to proceed with the policy, you can return the same and request for a refund within fifteen days from the date of receipt of the policy document.

Critical Illness Cover
Definition
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Critical Illness Cover

Includes additional coverage offered by some of the insurance companies to the insured upon diagnosis of any one of the listed critical illnesses. Read more.

During the policy term, if the insured member is diagnosed with any of the 11 specified critical illnesses, the insurance company will pay a lump sum of 10% of sum insured as an additional benefit.

Terms & Conditions

Room Rent / Room Category
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Room Rent / Room Category

Hospitals have a fixed tariff or rate chart for all rooms. Mediclaim depends on the amount of room rent limit specified in the policy document. The amount varies depending on the type of room category chosen.

You can claim for the hospitalization basis the following limits:

  • Room rent/boarding/nursing expenses up to a maximum of 1% of sum insured per day
  • ICU charges up to 2% of sum insured per day

Co-Payment
Definition
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Co-Payment

The fixed amount the policyholder has to pay for covered services when they get the service. When both insured and insurer pay part of the medical expenses, it is called as cost sharing. This is applicable based on the policy you choose.

For every admissible claim, the insurer has to bear a co-payment of 20% if he/she seeks the treatment in any hospital that is outside the Zone he has paid the premium. Similarly, If anyone buys the policy at the age of 55 years, he will have to bear a 20% Copay on admissible claim amount.

Sub-Limits
Definition
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Sub-Limits

Includes the limits up to which specific conditions are covered under your policy. These limits are applicable for packaged treatments or some specific ailments listed in the policy.

CATARACT CLAIMS: For cataract claims, your compensation will be restricted to 10% of sum insured or Rs.50,000 whichever less, for each eye.

Waiting Period

Cooling Off Period
Definition
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Cooling Off Period

The period begins right after commencement of the policy within which you cannot claim for any illness except claims related to accident. This period is not applicable for subsequent renewals.

A 30 days cooling off period for all claims except any arising out of accidental injuries.

Specific Illnesses
Definition
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Specific Illness

The ailments of specific severity listed in the policy document are included under this category.

The policy covers some specific diseases/treatments only after 18 or 24 months. These include Stone in Gall Bladder & Bile duct, Cataract, Hysterectomy, Myomectomy for Fibroids, and so forth.

Pre-Existing Illnesses
Definition
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Pre-Existing Illnesses

The ailments that the insured was already diagnosed with before taking the policy.

You can claim for any pre-existing conditions after a waiting period of 48 months from the policy start date.

Permanent Exclusions

    The Plan will not cover any liabilities towards the treatments of following conditions-

    • Whose signs or symptoms first occur within 30 days of the policy period
    • Attempted suicide
    • Use of alcohol or drug
    • AIDS
    • Pregnancy, childbirth, miscarriage, and abortion
    • Infertility and in vitro fertilization.
    • Vaccination & Inoculation
    • Hospitalization out of war, riot, strike and nuclear weapons

    Note: The complete list of what is omitted from the scope of coverage forms a part of the policy wordings. Kindly refer the same for additional reference.

Review of New India Assurance - Medclaim 2012 Policy

New India’s Mediclaim 2012 policy is an excellent investment to safeguard your family against the rising hospitalization costs. With valuable benefits like no claim bonus and a health check up at the end of every three claim free years, the policy is well-designed to tackle most of the expenses. However, a limit on the room rent and co-pay of 20% is something you need to think before you buy.

**Reviews and ratings are based only on Benefits and Conditions. Things like Claim Settlement Ratio, Hospital Network have not been covered under product ratings. These are covered under Company ratings.

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